Arkansas Independent Assessment (ARIA)Section II

section II - Arkansas Independent Assessment (ARIA)
Contents

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200.000Overview
201.000Arkansas Independent Assessment (ARIA) System Overview / 11-1-18

The Arkansas Independent Assessment (ARIA) system is comprised of several parts that are administered through separate steps for each eligible Medicaid individual served through one of the state’s waiver programs, or state plan personal care services. The purpose of the ARIA system is to perform a functional-needs assessment to assist in the development of an individual’s Person Centered Service Plan (PCSP), personal care services plan. As such, it assesses an individual’s capabilities and limitations in performing activities of daily living such as bathing, toileting and dressing. It is not a medical diagnosis, although the medical history of an individual is an important component of the assessment as a functional deficiency may be caused by an underlying medical condition. In the case of an individual in need of behavioral health services, or waiver services administered by the Division of Developmental Services (DDS), the independent assessment does not determine whether an individual is Medicaid eligible as that determination is made prior to and separately from the assessment of an individual.

Federal statutes and regulations require states to use an independent assessment for determining eligibility for certain services offered though Home and Community Based Services (HCBS) waivers. It is also important to Medicaid beneficiaries and their families that any type of assessment is based on tested and validated instruments that are objective and fair to everyone. In 2017, Arkansas selected the ARIA system which is being phased in over time among different population groups. When implemented for a population, the ARIA system replaces and voids any previous IA systems.

The ARIA system is administered by a vendor under contract with the Arkansas Department of Human Services (DHS). The basic foundation of the ARIA system is MnCHOICES, a comprehensive functional assessment tool originally developed by state and local officials in Minnesota for use in assessing the long-term services and supports (LTSS) needs of elderly individuals. Many individuals with developmental disabilities (DD)/intellectual disabilities (ID) and individuals with severe behavioral health needs also have LTSS needs. Therefore, the basic MnCHOICES tool has common elements across the different population groups. DHS and its vendor further customized MnCHOICES to reflect the Arkansas populations.

ARIA is administered by professional assessors who have successfully completed the vendor’s training curriculum. The assessor training is an important component of ensuring the consistency and validity of the tool. The assessment tool is a series of more than 300 questions that might be asked during an interview conducted in person. The interview may include family members and friends as well as the Medicaid beneficiary. How a question is answered may trigger another question. Responses are weighted based on the service needs being assessed. The MnChoices instrument is computerized and uses computer program language based on logic (an algorithm) to generate a tier assignment for each individual. An algorithm is simply a sequence of instructions that will produce the exact same result in order to ensure consistency and eliminate any interviewer bias.

The results of the assessment are provided to the individual and program staff at DHS. The results packet includes the individual’s tier result, scores, and answers to all questions asked during the IA. Click here to see an example results packet. Individuals have the opportunity to review those results and may contact the appropriate division for more information on their individual results, including any explanations for how their scores were determined. Depending upon which program the individual participates in, the results may also be given to service providers. The results will assign an individual into a tier which subsequently is used to develop the individual’s PCSP. The tiers and tiering logic are defined by DHS and are specific to the population served (personal care, DD/ID, BH). DHS and the vendor provide internal quality review of the IA results as part of the overall process. The tier definitions for each population group/waiver group are available in the respective section of this Manual. In the case of an individual whose services are delivered through the Provider-led Arkansas Shared Savings Entity (PASSE), the tier is used in the determination of the actuarially sound global payment made to the PASSE. Beginning January 1, 2019, each PASSE is responsible for its network of providers and payments to providers are based on the negotiated payment arrangements.

For beneficiaries receiving state plan personal care, the IA determines initial eligibility for services, then is used to inform the amount of services the beneficiary is to receive.

For clients who receive HCBS services, the IA results are used to develop the PCSP with the individual Medicaid beneficiary. The Medicaid beneficiary (or a parent or guardian on the individual’s behalf) will sign the PCSP. Depending upon which program the individual participates in, department staff or a provider is responsible for ensuring the PCSP is implemented. The DHS ARIA vendor does not participate in the development of the PCSP, nor in the provision of services under the approved plan.

There are four key features of every Medicaid home and community based services (HCBS) waiver:

  1. It is an alternative to care in an institutional setting (hospital, nursing home, intermediate care facility for individuals with developmental disabilities), therefore the individual must require a level of services and supports that would otherwise require that the individual be admitted to an institutional setting;
  2. The state must assure that the individual’s health and safety can be met in a non-institutional;
  3. The cost of services and supports is cost effective in comparison to the cost of care in an institutional setting; and,
  4. The PCSP should reflect the preferences of the individual and must be signed by the individual or their designee.

The PCSP, as agreed to by the Medicaid beneficiary, therefore represents the final decision for setting the amount, duration and scope of HCBSs for that individual.

201.100Developmental Screen Overview / 11-1-18

Additionally, the vendor will perform developmental screens for children seeking admission into an Early Intervention Day Treatment (EIDT) program, the successor program to Developmental Day Treatment Clinic Services (DDTCS) and Child Health Management Services (CHMS) described in Act 1017 of 2013. Ark. Code Ann. § 20-48-1102. The implementation of the screening process supports Arkansas Medicaid’s goal of using a tested and validated assessment tool that objectively evaluates an individual’s need for services.

The developmental screen is the Battelle Developmental Inventory screening tool, which is a norm-referenced tool commonly used in the field to screen children for possible developmental delays. The state has established a broad baseline and will use this tool to screen children to determine if further evaluation for services is warranted. The screening results can also be used by the EIDT provider to further determine what evaluations for services a child should receive.

202.000Assessor Qualifications Overview / 11-1-18

All Assessors who perform IAs or developmental screens on behalf of the vendor must meet the following qualifications:

A.At least one-year experience working directly with the population with whom they will administer the assessment

B.Have the ability to request and verify information from individuals being assessed

C.Culturally sensitive to individuals assessed

D.Have the necessary knowledge, skills and abilities to successfully perform and manage Independent Assessments including organization, time management, ability to address difficult questions and problematic individuals, effective communication, and knowledge of adult learning strategies

E.Linguistically competent in the language of the individual being assessed or in American Sign Language or with the assistance of non-verbal forms of communication, including assistive technology and other auxiliary aids, as appropriate to the individual assessed or use the services of a telephonic interpreter service or other equivalent means to conduct assessments

F.Verify the information received from the individual and the individual’s family members, caregivers, and/or guardians by cross-referencing all available information

G.SHALL NOT be related by blood or marriage to the individual or to any paid caregiver of the individual, financially responsible for the individual empowered to make financial or health-related decision on behalf of the individual, and would not benefit financially from the provision of assessed needs

203.000Appeals / 11-1-18

Appeal requests for the ARIA system must adhere to the policy set forth in the Medicaid Provider Manual Section 160.000 Administrative Reconsideration and Appeals which can be accessed at

204.000Severability / 11-1-18

Each section of this manual is severable from all others. If any section of this manual is held to be invalid, illegal or unenforceable, such determination shall not affect the validity of other sections in this manual and all such other sections shall remain in full force and effect. In such an event, all other sections shall be construed and enforced as if this section has not been included therein.

210.000Behavioral health services
210.100Referral Process / 11-1-18

Independent Assessment (IA) referrals are initiated by Behavioral Health (BH) Service providers identifying a beneficiary who may require services in addition to behavioral health counseling services and medication management. Requests for functional assessment shall be transmitted to the Department of Human Services (DHS) or its designee. Supporting documentation related to treatment services necessary to address functional deficits may be provided.

DHS or its designee will review the request and make a determination to either:

A.Finalize a referral and sent it to the vendor for a BH IA

B.Provide notification to the requesting BH service provider that more information is needed

C.Provide notification to the requesting entity

Reassessments will occur annually, unless a change in circumstances requires a new assessment.

210.200Assessor Qualifications / 11-1-18

In addition to the qualifications listed in Section 102.000, BH assessors must have a four (4) year Bachelor’s degree or be a Registered Nurse with at least one year of mental health experience.

210.300Tiering / 11-1-18

A.Tier definitions:

1.Tier 1 means the score reflected that the individual can continue Counseling and Medication Management services but is not eligible for the additional array of services available in Tier 2 or Tier 3

2.Tier 2 means the score reflected difficulties with certain behaviors allowing eligibility for a full array of non-residential services to help the beneficiary function in home and community settings and move towards recovery.

3.Tier 3 means in the score reflected difficulties with certain behaviors allowing eligibility for a full array of services including 24 hours a day/7 days a week residential services, to help the beneficiary move towards reintegrating back into the community.

B.Tier Logic

1.Beneficiaries age 18 and over

Tier 1 – Counseling and Medication Management Services / Tier 2 – Counseling, Medication Management, and Support Services / Tier 3 – Counseling, Medication Management, Support, and Residential Services
Criteria that will Trigger Tiers
Behavior / Does not meet criteria of Tier 2 or Tier 3 / Mental Health Diagnosis Score of 4
AND
Intervention Score of 1 or 2 in any ONE of the following Psychosocial Subdomains:
Injurious to Self
Aggressive Toward Others, Physical Aggressive Toward Others,
Verbal/Gestural Socially Unacceptable Behavior
Property Destruction
Wandering/Elopement
PICA / Mental Health Diagnosis Score of 4
AND
Intervention Score of 3 or 4 in any ONE of the following Psychosocial Subdomains:
Injurious to Self
Aggressive Toward Others, Physical Aggressive Toward Others,
Verbal/Gestural Socially Unacceptable Behavior
Property Destruction
Wandering/Elopement
PICA
OR
Mental Health Diagnosis Score of 4
AND
Intervention Score of 3 or 4
AND
Frequency Score of 4 or 5 in any ONE of the following Psychosocial Subdomains:
Difficulties Regulating Emotions
Susceptibility to Victimization
Withdrawal
Agitation
Impulsivity
Intrusiveness
OR
Mental Health Diagnosis Score of 4
AND
Intervention Score of 1, 2, 3 or 4
AND
Frequency Score of 1, 2, 3, 4 or 5 in the following Psychosocial Subdomain:
Psychotic Behaviors
OR
Mental Health Diagnosis Score of 4
AND
Intervention Score of 4
AND
Frequency Score of 4 or 5 in the following Psychosocial Subdomain:
Manic Behaviors
OR
Mental Health Diagnosis Score of 4
AND
PHQ-9 Score of 3 or 4
(Moderately Severe or Severe Depression)
OR
Geriatric Depression Score of 3 (>=10)
OR
Mental Health Diagnosis Score of 4
AND
Substance Abuse or Alcohol Use Score of 3

When you see “AND”, this means you must have a score in this area AND a score in another area. When you see “OR”, this means you must have a score in this area OR a score in another area.

2.Beneficiaries Under Age 18

Tier 1 – Counseling and Medication Management Services / Tier 2 – Counseling, Medication Management, and Support Services / Tier 3 – Counseling, Medication Management, Support, and Residential Services
Criteria that will Trigger Tiers
Behavior / Does not meet criteria of Tier 2 or Tier 3 / Mental Health Diagnosis Score >= 2
AND
Injurious to Self:
Intervention Score of 1, 2 or 3
AND
Frequency Score of 1, 2, 3, 4 or 5 / Mental Health Diagnosis Score >=2
AND
Injurious to Self:
Intervention Score of 4
AND
Frequency Score of 1, 2, 3, 4 or 5
OR
Mental Health Diagnosis Score >=2
AND
Aggressive Toward Others, Physical:
Intervention Score of 1, 2 or 3
AND
Frequency Score of 1, 2, 3, 4 or 5 / Mental Health Diagnosis Score >=2
AND
Aggressive Toward Others, Physical:
Intervention Score of 4
AND
Frequency Score of 2, 3, 4 or 5
OR
Mental Health Diagnosis Score >=2
AND
Intervention Score of 3 or 4
AND
Frequency Score of 2, 3, 4, or 5
in any ONE of the following Psychosocial Subdomains:
Aggressive Toward Others, Verbal/Gestural
Wandering/Elopement / Mental Health Diagnosis Score >=2
AND
Psychotic Behaviors:
Intervention Score of 3 or 4
AND
Frequency Score of 3, 4 or 5
OR
Mental Health Diagnosis Score >=2
AND
Intervention Score of 2, 3 or 4
AND
Frequency Score of 2, 3, 4, or 5
in any ONE of the following Psychosocial Subdomains:
Socially Unacceptable Behavior
Property Destruction
OR
Mental Health Diagnosis Score >=2
AND
Intervention Score of 3 or 4
AND
Frequency Score of 3, 4, or 5 in any ONE of the following Psychosocial Subdomains:
Agitation
Anxiety
Difficulties Regulating Emotions
Impulsivity
Injury to Others, Unintentional
Manic Behaviors
Susceptibility to Victimization
Withdrawal
OR
Mental Health Diagnosis Score >=2
AND
PICA:
Intervention Score of 4
OR
Mental Health Diagnosis Score >=2
AND
Intrusiveness:
Intervention Score of 3 or 4
AND
Frequency Score of 4 or 5
OR
Mental Health Diagnosis Score >=2
AND
Psychotic Behaviors:
Intervention Score of 1 or 2
AND
Frequency Score of 1 or 2
OR
Mental Health Diagnosis Score >=2
AND
Psychosocial Subdomain Score >=5 and <=7
AND
Pediatric Symptom Checklist Score >15
210.400Possible Outcomes / 11-1-18

A.For a beneficiary receiving a Tier 1 determination:

1.Eligible for Counseling and Medication Management services and may continue Tier 1 services with a certified behavioral health service provider.

2.Not eligible for Tier 2 or Tier 3 services.

3.Not eligible for auto-assignment to a Provider-led Arkansas Shared Savings Entity (PASSE) or to continue participation with a PASSE.

B.For a beneficiary receiving a Tier 2 determination:

1.Eligible for services contained in Tier 1 and Tier 2.

2.Not eligible for Tier 3 services.

3.Eligible for auto-assignment to a PASSE or to continue participation with a PASSE.

a.On January 1, 2019, the PASSE will receive a PMPM that corresponds to the determined rate for the assigned tier.

b.The PASSE will be responsible for providing care coordination an assisting the beneficiary in accessing all needed services and, after January 1, 2019, for providing those services.

C.For a beneficiary receiving a Tier 3 determination:

1.Eligible for services contained in Tier 1, Tier 2 and Tier 3.

2.Eligible for auto-assignment to a PASSE or to continue participation with a PASSE.

a.On January 1, 2019, the PASSE will receive a PMPM that corresponds to the determined rate for the assigned tier.

b.The PASSE will be responsible for providing care coordination and assisting the beneficiary in accessing all needed services and, after January 1, 2019, for ensuring those services are provided.

220.000developmental/intellectual disabilities services
220.100Independent Assessment Referral Process / 11-1-18

A.Independent Assessment (IA) referrals are initiated by the Division of Developmental Disabilities (DDS) when a beneficiary has been determined, at one time, to meet the institutional level of care. DDS will send the referral for a Developmental Disabilities (DD) Assessment to the current IA Vendor. DDS will make IA referrals for the following populations:

1.Clients receiving services under the Community and Employment Supports (CES) 1915(c) Home and Community Based Services Waiver.

2.Clients on or applying for the CES Waiver Waitlist.

3.Clients applying for or currently living in a private Intermediate Care Facility (ICF) for individuals with intellectual or developmental disabilities.

4.Clients who are applying for placement at a state-run Human Development Center (HDC).

To continue to receive services within these populations, all individuals referred will have to undergo the Independent Assessment.

B.All populations, except for those served at an HDC, will be reassessed every three (3) years.

1.An individual can be reassessed at any time if there is a change of circumstances that requires a new assessment.

2.Individuals in an HDC will only be reassessed if they are seeking transition into the community.

220.200Assessor Qualifications / 11-1-18

In addition to the qualifications listed in Section 202.000, DD assessors must have at least two-years’ experience with the ID/DD population and meet the qualifications of a Qualified Developmental Disability Professional (QDDP).

220.300Tiering / 11-1-18

A.Tier Definitions:

1.Tier 2 means that the beneficiary scored high enough in certain areas to be eligible for paid services and supports.

2.Tier 3 means that the beneficiary scored high enough in certain areas to be eligible for the most intensive level of services, including 24 hours a day/7 days a week paid supports and services.

B.Tiering Logic:

1.DDS Tier Logic is organized by categories of need, as follows:

a.Safety: Your ability to remain safe and out of harm’s way

b.Behavior: behaviors that could place you or others in harm’s way

c.Self-Care: Your ability to take care of yourself, like bathing yourself, getting dressed, preparing your meals, shopping, or going to the bathroom

Tier 2: Institutional Level of Care / Tier 3: Institutional Level of Care and may need 24 hours a day 7 days a week paid supports and services to maintain current placement